5 Unexpected Prejudices Faced by Nurses

A recent email, from an anonymous reader, expressed a fervent distaste for the nurse practitioner profession and our role in modern medicine. While I’m certainly immune at this point to hateful email (#hatermail), I was particularly disheartened because this individual asserted a refusal to engage professionally (or even personally) with nurse practitioners. Looks like it’s time to discuss prejudice against nurses and nurse practitioners.

I loathe the impact such discrimination can have on patient well-being. This is not okay. Nurse practitioners and physicians are colleagues, partners, and equals, if by nothing else, by our allegiance to the Hippocratic Oath. Working together professionally is not a choice, it is our duty to our patients.

So, without further ado, please read, comment, and send me more emails about one of my more controversial posts 5 Unexpected Prejudices Faced by Nurses.

I originally wrote this article way back in September 2015 on the Nurses @ Microsoft Blog, but I wanted to bring it back to light after receiving a particular email.

It’s official! I finally graduated with a doctorate in nursing practice. It was 8 years ago that I started nursing school, yet it seems like yesterday that I told my high school counselor I wanted to become a criminal-profiler-philosopher-painter-inventor. Turns out, being a nurse practitioner isn’t too bad either.

What drew me to the nursing profession were the science courses, holistic philosophy of treatment, and ability to begin clinical care immediately. I entered nursing school in August 2007 full of determination, armed with a stethoscope and pathophysiology textbook. Like your prototypical type-A nurse, I came equipped with pens, sticky notes, highlighters, three-ring binders, reference books, coffee, and my computer. However, what I wasn’t prepared for were the five unlikely prejudices on my journey to becoming a doctor of nursing practice.

You are too smart for nursing school.

The first time I heard this was from a family member. Then I heard it again from friends and colleagues. Initially, I was confused by this assertion: “Uh oh, I must not be very smart because nursing school is actually really challenging.” Over time I realized that the problem was a public misunderstanding. Actually, I was smart enough to go to nursing school.

Here are a few things I think the world should know about nursing school. First, we take science classes. Yes, that means we study anatomy, physiology, chemistry, microbiology, pharmacology, and pathophysiology. Second, we must pass standardized benchmarking exams every year. Third, we don’t wear white dresses and hats. Fourth, we aren’t all women, and the number of males entering the profession continues to grow. Fifth, we undergo extensive clinical rotations beginning in our undergraduate studies. Sixth, we are not trained to obey doctor’s orders; in fact, we are educated to provide autonomous and collaborative care of all individuals either sick or well across all settings.

Licensed practical nurses are not real nurses. 

During my undergraduate studies, I worked as a mental health specialist & student nurse at a child and adolescent psychiatric hospital. A licensed practical nurse (LPN) on my unit became my mentor and inspiration: she supported me, empowered me, and guided me. She taught me how to lead group therapy sessions, monitor medication side effects, and effectively use de-escalation techniques. I will never forget her passion and enthusiasm for caring for children with mental illness.

Throughout my career, I’ve heard registered nurses (RNs) and nurse practitioners (NPs) make unnecessarily negative statements about the competence of LPNs: “They’re not real nurses.” This is absolutely not true. Licensed practical nurses, registered nurses, and nurse practitioners are all real nurses, and we work side by side, inextricably bound by the vision of improving our patients’ lives.

You can’t go straight from nursing school to nurse practitioner school. 

After about three years of nursing school, I knew I wanted to be a nurse practitioner. I admired the nurse practitioners I encountered in practice, and I was fascinated by their role in patient care. However, when I decided to go straight to nurse practitioner school, I was met with resistance. Instead of affirmations or words of encouragement, my undergraduate professors advised me otherwise, saying, “You need at least one year of medical-surgical nursing experience first.”
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Ultimately, I attended nurse practitioner school immediately after graduation. Because I never worked as an RN, I am sometimes referred to as a “non-nurse nurse practitioner.” This term has shadowed me through my masters and doctorate program making me constantly question my “nurse-ness.” However, despite my lack of RN experience, I still became a great nurse practitioner.

Now that you’re a nurse practitioner, when are you applying to medical school?

To become a medical doctor, you must go to medical school. To become a dentist, you must go to dental school. To become a nurse practitioner, you must go to nurse practitioner school. Asking a nurse practitioner when she is going to medical school is nonsensical, yet I’m asked this question all the time.

Nurse practitioners are a distinctive type of healthcare provider who diagnose and treat medical conditions. We prescribe medication, order and interpret diagnostic tests, and perform invasive procedures. Nursing theory serves as the foundation of our philosophy of care: we approach patient care holistically by emphasizing health promotion, disease prevention, and health education.

Nurse practitioners choose to specialize in acute care, adult health, family health, gerontology, neonatal health, oncology, pediatrics, psychiatry, or women’s health. We subspecialize in immunology, cardiology, dermatology, emergency, endocrinology, gastroenterology, neurology, occupational health, orthopedics, pulmonology, sports medicine, and urology. Nurse practitioners don’t need to go to medical school because they are already nurse practitioners.

A doctor of nursing practice is not a real doctor.

Nurse practitioners may choose to seek a professional doctorate, typically a doctor of nursing practice (DNP) degree. With more and more nurse practitioners earning their doctorate degree, interdisciplinary controversy has ensued. Should nurse practitioners be allowed to address themselves as Doctor?

Historically, only Doctors of Medicine (MD), Doctors of Osteopathic Medicine (DO), Dentists (DDS or DMD), Doctors of Podiatric Medicine (DPM), Doctors of Optometry (OD), Doctors of Psychology (Psy. D), and Doctors of Chiropractic (DC) have referred to themselves as “doctors” in a clinical setting. Unfortunately, adding DNP to this list has been met with opposition.

The title doctor comes from the Latin word docere meaning to teach. This designation has never referred exclusively to specific types of doctors but instead to any person receiving a doctoral degree in any field (for more info, read this book). The label “doctor” is common to many disciplines, and it is not the domain of any one group of healthcare providers.

As a nurse practitioner, never has it been my intention to misrepresent myself as an MD, DO, DDS, DMD, DPM, OD, Psy.D or DC. I am proud to be a DNP. I resolve that we respect each other’s accomplishments and value the unique contributions of each professional. We should use our distinct perspectives to the advantage of our patients, not as a means to divide us.

Conclusion

When I was first confronted by these unexpected prejudices, I was unassuming—just observing and quietly wondering, “This doesn’t seem right…” Eight years and 150+ credit hours later, I’ve become a spitfire, not missing a chance to stand up for myself or my colleagues. Although these invisible prejudices ache, they have shaped me (and many other nurses) into fierce advocates poised for reformation.

In the face of these challenges, all nurses must stand together and remain united in our vision of improving the health and well-being of individuals, both locally and globally. With our determination, we can be a powerful force in shaping the future of healthcare.

I originally wrote this article for the Nurses @ Microsoft Blog. Please check out their latest posts from nurses and nurse practitioners around the world. Full disclosure: while at the time I wrote this article I was not employed by Microsoft, I am today. I currently work in the Windows Devices Group as a Design Researcher. ​